Are there female-specific risk factors for diabetes?
Diabetes is now the leading cause of female deaths in South Africa, according to figures from Statistics South Africa. With coronary heart disease established as the leading cause of death in people with diabetes, an endocrinologist at Mediclinic Worcester looks at the risk factors for diabetes that are exclusive to women.
According to recently-released figures from Statistics South Africa, 15 506 South African women died from diabetes in 2016. Diabetes is, therefore, responsible for 16% more deaths than the number two natural cause of death, cerebrovascular diseases. While treatment for diabetes is gender-neutral there are some gender-specific risk factors for women. Dr Francois van Zyl, an endocrinologist at Mediclinic Worcester sheds some light on these risks, on the presentation of heart disease in diabetics and on the recommended precautions.
Risk factors for diabetes in women
According to Dr van Zyl, risk factors common to both women and men include:
- genetic predisposition
- advancing age
- a sedentary lifestyle
Significant comorbid diseases of type 2 Diabetes – additional diseases that occur together with the primary disease –are high blood pressure and dyslipidemia, both increase the risk of cardiovascular complications.
When it comes to female patients and possible unique risks, age is an important factor to consider. Patients of child-bearing age who have a family history of type 2 diabetes should be aware of the potential risk of developing the condition during pregnancy. The health implications are profound for both mother and child.
“Prior to conception, glucose control must be optimal and during the baby’s development, good glycaemic control must be maintained to reduce the risk of complications during and after pregnancy,” says Dr van Zyl. “There is a unique epigenetic impact here too – the foetus may be influenced long-term in terms of their risk of developing diabetes later in life. Adequate treatment of diabetes in pregnancy is therefore vital.”
In post-menopausal female patients, the use of hormone replacement therapy may have some potential cardiovascular risk implications, especially if initiated after the age of 60. “We individualise therapy, but generally we don’t advocate the use of hormone replacement therapy in diabetic patients with established coronary artery disease.
“In the vast majority of diabetic patients older than 50, they are considered as coronary risk equivalent,” he continues. Here your risk is equivalent to someone who already sustained a macrovascular complication like a heart attack or stroke. “That’s why we’re very vigilant in these patients and treatments are advocated in accordance with international consensus guidelines.”
Heart disease and diabetes
Heart disease in diabetic patients is not always easily identifiable. “Symptoms may be atypical,” explains Dr van Zyl. “Diabetic patients may be asymptomatic and may present with so-called silent ischemia. They could have damage to the muscle of the heart because of poor blood flow, without any pain. “
Dr van Zyl adds that before you’re diagnosed with diabetes, you could have already been exposed to high levels of glucose for longer than ten years. “That’s why when patients present, especially after the age of 50, we assume there’s already some degree of vascular damage. Therefore we’re very proactive in our surveillance strategies. We look for signs of blood vessel damage and the involvement of target organs including the heart, kidneys, eyes and nerves, on routine health checks. If patients have evidence of microvascular damage – affecting the walls and inner lining of tiny arteries – there’s an association with increased risk of macrovascular complications.”
Heart disease prevention
When it comes to the prevention of heart disease, guidelines and treatment remain gender neutral. Heart disease prevention is ultimately the same for male and female patients, says Dr van Zyl. “We look at treating to SEMDSA guideline targets, which include maintaining normal glucose levels, good blood pressure and lipid control. We do this with a holistic approach that focuses on lifestyle modifications like:
- balanced sustainable diets
- weight loss
- smoking cessation
- appropriate pharmacotherapy
We individualise treatments to benefit patients and limit potential risks. In accordance with the FDA (Food and Drug Administration) and the EMA (European Medicines Agency), all new treatments need to show clear cardiovascular benefit and safety.”